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Research Interests: Minerals, Menopause, Exercise therapy, Medicine, Physical Therapy, and 15 morePostmenopausal Women, Osteoporosis, Humans, Female, Aged, Middle Aged, Randomized Controlled Trial, Mayo Clinic Proceedings, Bone and Bones, Isometric Contraction, lumbar vertebrae, Random Allocation, Clinical Trials as Topic, Medical and Health Sciences, and Spinal diseases
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Burden, Risk Factors, and Prevention of Osteoporosis.- Physiology and Pathophysiology of Bone and Muscle.- Challenging Complications Related to Reduction of Biomechanical Competence of the Axial Skeleton.- Consequences of Bone Loss and... more
Burden, Risk Factors, and Prevention of Osteoporosis.- Physiology and Pathophysiology of Bone and Muscle.- Challenging Complications Related to Reduction of Biomechanical Competence of the Axial Skeleton.- Consequences of Bone Loss and Sarcopenia.- Role of Nutrition in Musculoskeletal Health.- Rehabilitation after Vertebral Fracture.- Exercise for Patients with Established Osteoporosis.- Exercise for the Prevention of Bone Loss.- Exercise for Treatment Post-Fracture.- The Role of Orthotics in Osteoporosis.- Whole Body Vibration: Physiology and Effect on Muscle and Bone.- Application of Electrical Modalities on Muscle Stimulation.- Kyphoplasty and Vertebroplasty: Benefits and Side-Affects.- Gait Aids for Prevention and Management of Falls.- Risk of Falls and Preventive Strategies.- Rehabilitation after Hip Fracture.- Pain Management and Quality of Life.- Recreational Exercises and Osteoporosis: Relaxation Techniques, Yoga and Tai Chi.
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Every medical student at Mayo Medical School participates in a three-week training program in the department of physical medicine and rehabilitation. Since 1974-1975, approximately 40 students have had this experience each academic year.... more
Every medical student at Mayo Medical School participates in a three-week training program in the department of physical medicine and rehabilitation. Since 1974-1975, approximately 40 students have had this experience each academic year. In addition to lectures, the learning experience includes clinical cases involving hospitalized patients and outpatients. Students are evaluated by written and oral examinations. At the end of the course, the students submit a list of patients seen during their rotation and another list of procedures they learned. For the classes of 1980, 1981, and 1982, the frequency of medical conditions seen and procedures learned by the medical students have been computed. The most common conditions seen by the 116 students were low back pain (92.2%), hemiplegia (87.9%), paraplegia (85.3%), quadriplegia (81%), and tension myalgia (79.3%). The procedures learned and demonstrated most frequently were crutch gaits (95.7%), muscle testing (94%), and goniometry (94%). Sixty students returned course evaluation forms at the conclusion of the program, the results of which indicated that high value is placed on this educational program.
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In this communication the physical therapy and rehabilitation measures utilized in the management of patients with spinal osteoporosis are discussed. The bone loss and the subsequent bone disease that occur in some older persons, and... more
In this communication the physical therapy and rehabilitation measures utilized in the management of patients with spinal osteoporosis are discussed. The bone loss and the subsequent bone disease that occur in some older persons, and especially in postmenopausal women, call for special physical therapeutic measures. One should be cautious about prescribing exercises, for some may predispose the spine to undue sprain and strain. This principle applies to any exercise program, whether therapeutic or recreational.
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Most studies of depression after stroke have included heterogeneous samples of patients. These studies have generally not qualified patients as to age, absence of neurologic, psychiatric, and substance abuse histories, and other... more
Most studies of depression after stroke have included heterogeneous samples of patients. These studies have generally not qualified patients as to age, absence of neurologic, psychiatric, and substance abuse histories, and other complicating factors. Of 155 inpatient rehabilitation admissions after acute unilateral cerebrovascular accident, only 26 met the following strict criteria for inclusion: age older than 55 years, no history of or concomitant brain disease or injury, and no history of major affective, thought, or substance abuse disorder. Two examiners independently administered the Hamilton Depression Rating Scale, a mood adjective checklist, and a modified Mini-Mental State Examination to 20 subjects who agreed to participate. They also rated subjects on research diagnostic criteria for depression and obtained a dexamethasone suppression test for each subject. Eighteen subjects completed neuropsychologic evaluation. All evaluations were completed within six weeks of the patient's stroke. Subjects fell into four distinct clinical groups based on averaged data: (1) no affective symptoms, (2) verbal distress only, (3) vegetative symptoms only, and (4) a combined disorder with both distress and vegetative symptoms. The presence of verbal reports of distress, vegetative signs, or both were associated with longer hospital stays and greater neuropsychologic impairment.
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Forty-eight patients with symptomatic back pain secondary to spondylolisthesis who were treated conservatively were followed for three years after initial examination to compare the outcomes of two exercise programs. The patients were... more
Forty-eight patients with symptomatic back pain secondary to spondylolisthesis who were treated conservatively were followed for three years after initial examination to compare the outcomes of two exercise programs. The patients were divided into two groups--those doing flexion and those doing extension back strengthening exercises. All patients received instructions on posture, lifting techniques, and the use of heat for relief of symptoms. After three months, only 27% of patients who were instructed in flexion exercises had moderate or severe pain and only 32% were unable to work or had limited their work. Of the patients who were instructed in extension exercises, 67% had moderate or severe pain and 61% were unable to work or had limited their work. At three-year follow-up, only 19% of the flexion group had moderate or severe pain and 24% were unable to work or had limited their work. The respective figures for the extension group were 67% and 61%. The overall recovery rate after three months was 58% for the flexion group and 6% for the extension group. At three years these figures improved to 62% for the flexion group and dropped to 0% for the extension group. The literature is scarce regarding the applicability of conservative treatment programs for lumbar spondylolisthesis. On the basis of our findings, we suggest that if a conservative treatment program is elected, back flexion or isometric back strengthening exercises should be considered. The three-year follow-up data presented here lend support to this point of view.
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In this prospective study, the efficacy of exercise on the strength of the back extensors was evaluated. Fifty healthy women volunteers, aged 40 to 65 years (mean = 56 years), participated in a back exercise program. Subjects were... more
In this prospective study, the efficacy of exercise on the strength of the back extensors was evaluated. Fifty healthy women volunteers, aged 40 to 65 years (mean = 56 years), participated in a back exercise program. Subjects were screened to exclude those with diseases or treatment programs that could affect muscle strength. Seventeen subjects participated in a conventional back strengthening program, consisting mainly of antigravity upper back extension exercises in the prone position. Thirty-three control subjects continued to perform their usual athletic and daily physical activities. The control group were postmenopausal women who had volunteered to participate in a study of the effect of back strengthening exercises on bone mineral density. Subjects were blindly assigned to the control group without any selection procedures. We used this group as the control for this study because two studies were performed concurrently, and it seemed unnecessary to have two control groups. All subjects were instructed in proper posture principles. Physical activity and back extensor strength were evaluated every four to six weeks for three months. Milestones were completed by 16 subjects in the exercise group and 31 control subjects. The strength of the back extensors was significantly increased (p less than 0.001) in the exercise group. This study indicates that the back extensors can be strengthened with conventional back extension exercise.
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Combining pharmacotherapy with non-pharmacotherapy is fundamental to the successful management of osteopenia and osteoporosis. The choice of pharmacotherapy depends on the patient’s age, bone mineral density and serum biochemical markers... more
Combining pharmacotherapy with non-pharmacotherapy is fundamental to the successful management of osteopenia and osteoporosis. The choice of pharmacotherapy depends on the patient’s age, bone mineral density and serum biochemical markers of bone. HRT should not be used for treatment of osteoporosis. As with pharmacotherapy, rehabilitation management is challenging and innovative. Non-pathologic spontaneous vertebral fractures that occur at the level of the spine are purely osteoporosis-related. On the other hand, the majority of non-vertebral fractures that are of special clinical significance are fall-related. Therefore, reducing the risk for fracture through the prevention of falls is as important as increasing bone mass. (From the World of Osteoporosis 2009;15:52-8)
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ZusammenfassungDas Ziel der Medizinischen Trainingstherapie bei Osteoporose und Wirbelkörperfrakturen besteht darin, die Rückenmuskulatur zur Verbesserung einer aufrechten Körperhaltung zu kräftigen. Deshalb sollte ein spezifisches... more
ZusammenfassungDas Ziel der Medizinischen Trainingstherapie bei Osteoporose und Wirbelkörperfrakturen besteht darin, die Rückenmuskulatur zur Verbesserung einer aufrechten Körperhaltung zu kräftigen. Deshalb sollte ein spezifisches Trainingsprogramm entsprechend den individuellen Fähigkeiten der Patienten zuerst im Sitzen begonnen werden, um dann mit zunehmendem Kraftzuwachs auf das Stehen überzugehen. Mit abnehmender Brüchigkeit und zunehmender Stabilität kann dann auch ein isometrisches Krafttraining für die Rückenmuskulatur begonnen werden. Durch ein derartiges Training konnte im Rahmen einer prospektiven randomisierten Studie bei peri- oder unmittelbar postmenopausalen Frauen bei zunehmender Kraft der Rückenmuskulatur das spätere Auftreten von Wirbelkörperfrakturen um etwa zwei Drittel gesenkt werden. Zusätzlich können durch das „SPEED-Programm“ signifikante Verbesserungen von Rückenschmerzen, Kyphose, Sturzrisiko und Leistungsfähigkeit im Alltag erreicht werden. Dabei handelt es sich um ein dynamisches, propriozeptives Training zur Kräftigung der Rückenextensoren. Hierzu wird das „Posture Training Support“ (PTS) eingesetzt. Diese Unterstützung besteht aus einem, je nach Trainingszustand, unterschiedlich schweren Rucksack, der zu einer Abnahme von Rundrücken und Schmerzen führen kann, wie sie durch Wirbelkörperkompressionsfrakturen entstanden sind. Durch die verbesserte Aufrichtung wird dann auch ein Reiben von Rippen auf den Beckenkämmen, was in extremen Fällen durchaus auftreten kann, vermieden.Insgesamt sollte die medizinische Trainingstherapie zu einer Zunahme an Muskelkraft führen, ohne die Wirbelsäule durch zusätzliche Kräfte zu sehr zu belasten. Dadurch gelingt es dann auch, Stürzen und Frakturen vorzubeugen. Ähnlich wie bei der medikamentösen Behandlung sollte auch die Bewegungstherapie individuell dosiert werden.Im Rahmen der Rehabilitation können flexible, semi-rigide Rückenorthesen an die individuelle Form der Wirbelsäule angepasst werden. Über einen sogenannten „Biofeedback-Mechanismus“ kann ebenfalls eine Kraftzunahme im Bereich der Rumpfmuskulatur bei vorhandenen Wirbelkörperfrakturen erreicht werden. Vermutlich über eine Schmerzreduktion ist eine erhöhte Leistungsfähigkeit im Alltag erreichbar. Klinische Studien zeigen, dass im Verlauf einer Tragezeit von 6 bis 12 Monaten durch eine Kräftigung der Rückenstrecker eine aufrechtere Haltung mit verbessertem Standgleichgewicht erzielbar ist. Möglicherweise kann hierdurch auch eine Verringerung der Sturz- und Frakturrate erreicht werden.
Research Interests: Medicine and Gynecology
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This study of postmenopausal women had two objectives: (1) to determine whether there is a correlation between the strength of grip muscles and bone mineral content in the midradius where these muscles attach, and (2) to determine whether... more
This study of postmenopausal women had two objectives: (1) to determine whether there is a correlation between the strength of grip muscles and bone mineral content in the midradius where these muscles attach, and (2) to determine whether this correlation is of sufficient magnitude to predict cortical bone content by measuring grip muscle strength. Nondominant power grip and bone mineral content of the midradius were measured in 63 healthy postmenopausal Caucasian women. Significant positive correlations (p less than 0.001) were noted between regional bone mineral content and nondominant power grip, and significant negative correlations (p less than 0.001) were found between nondominant power grip and age and between regional bone mineral content and age. When bone mineral data were normalized for skeletal size, there was no significant improvement of the correlation. In addition, the correlation between grip strength and bone mineral content at the midradius was not sufficiently strong to permit the use of grip strength measurements for prediction of midradius bone mineral content for clinical decision-making or epidemiologic studies. Furthermore, the correlation between grip strength and bone mineral content at the muscle insertion site was not better than the correlation between grip strength and bone mineral content at more distal sites on the same bone.
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Bone formation and resorption are ongoing phenomena. When bone resorption equals bone formation, bone mass remains stable. When resorption exceeds formation, bone mass is reduced--a process that leads to osteopenia or osteoporosis.... more
Bone formation and resorption are ongoing phenomena. When bone resorption equals bone formation, bone mass remains stable. When resorption exceeds formation, bone mass is reduced--a process that leads to osteopenia or osteoporosis. Osteopenia is reduced bone mass and osteoporosis is reduced bone mass with resultant fractures. Reduced bone mass may be postmenopausal or related to ovarian failure (type I osteoporosis), it may be age-related (type II osteoporosis), or it may result from several other etiologic factors (secondary osteoporosis). Disuse and inactivity can cause bone loss, whereas weight-bearing exercises may maintain or improve bone mineral density. There is a significant correlation between muscle strength and bone mineral density. There is evidence that strengthening exercises may lead to an increase in the mineral density of the bones to which the muscles are attached. Currently, drug regimens are available to decrease or halt bone loss in osteoporotic patients. Properly designed exercise programs may prove to be effective for retarding age-related bone loss. In patients with osteoporosis, the cause should be investigated before treatment is commenced.
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The objective of this study was to evaluate any correlation between the muscle strength of the upper extremity (appendicular muscles) and that of the back extensors (axial muscles) in postmenopausal women. Back extensor strength and power... more
The objective of this study was to evaluate any correlation between the muscle strength of the upper extremity (appendicular muscles) and that of the back extensors (axial muscles) in postmenopausal women. Back extensor strength and power grip of the dominant hand were measured in 68 healthy postmenopausal women. The level of physical activity was determined according to a scale (score, 0-18) that considered vocational and avocational activities. Statistical analysis demonstrated a significant positive correlation between back extensor strength and power grip (r = 0.46, P less than 0.001) and back extensor strength and level of physical activity (r = 0.37, P less than 0.002). The correlation between level of physical activity and power grip was much less significant (r = 0.25, P less than 0.05) than that between physical activity and back strength. These data suggest that, in healthy individuals, stronger grip may also indicate stronger back extensor muscles. They also demonstrate that physical activity contributes significantly to the back extensor strength and, to a lesser degree, to the strength of the upper extremities.
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Fifty-nine women with postmenopausal spinal osteoporosis and back pain were instructed in a treatment program that included extension exercises (E) for 25 patients, flexion exercises (F) for 9, combined (E + F) exercises for 19, or no... more
Fifty-nine women with postmenopausal spinal osteoporosis and back pain were instructed in a treatment program that included extension exercises (E) for 25 patients, flexion exercises (F) for 9, combined (E + F) exercises for 19, or no therapeutic exercises (N) for 6. Ages ranged from 49 to 60 years (mean, 56 years). Follow-up ranged from one to six years (means for the groups, 1.4 to 2 years). All patients had spine x-ray studies before treatment and at follow-up, at which time any further wedging and compression fractures were recorded. Additional fractures occurred as follows: group E, 16%; F, 89%; E + F, 53%; and N, 67%. In comparison with group E, the occurrence of wedging or compression fractures was significantly higher in group F (p less than 0.001) and group E + F (p less than 0.01). This study suggests that a significantly higher number of vertebral compression fractures occur in patients with postmenopausal osteoporosis who followed a flexion exercise program compared with...
Research Interests: Menopause, Exercise therapy, Medicine, Physical Therapy, Postmenopausal Women, and 13 moreOsteoporosis, Humans, Female, Pubmed, Follow-up studies, Clinical Sciences, Middle Aged, Public health systems and services research, Time Factors, Isometric Exercise, Spinal Cord Injuries, Isometric Contraction, and Spinal diseases
Research Interests: Neurology, Higher Education, Waste Management, Claude Lévi-Strauss, Educación, and 13 moreEmprendimiento, Arte, Neuroradiology, Trabajo Social, Liderazgo, Clinical Sciences, Gerencia, Responsabilidad Social, Polìtica, Investigaciòn, Desarrollo Sociopolìtico cultural y econòmico, Gestiòn, and Neurosciences
The medical records of 31 patients (19 male and 12 female) with clinical and electrophysiologic features of Wohlfart-Kugelberg-Welander syndrome were reviewed. The reported age at onset ranged from less than one year to 46 years, and the... more
The medical records of 31 patients (19 male and 12 female) with clinical and electrophysiologic features of Wohlfart-Kugelberg-Welander syndrome were reviewed. The reported age at onset ranged from less than one year to 46 years, and the age at diagnosis ranged from three to 66 years. Proximal muscle weakness, especially of the lower extremities, and muscular atrophy were the predominant clinical features. Elevated serum creatine kinase levels were noted in four female and 12 male patients, and the degree of elevation was higher in the male patients (up to 32 times the upper limit of normal) than in the female patients. On initial evaluation, two patients were wheelchair-bound, whereas the others were ambulatory. On follow-up evaluation three to 32 years later (mean, 15.5 years), 11 patients used wheelchairs, although only three were wheelchair-bound. The disease followed a steady, slowly progressive course. The outcome of ambulatory status did not correlate with the initial creatine kinase determination.
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Rehabilitation techniques for the management of patients with amyotrophic lateral sclerosis are aimed at maintaining the patients at their optimum functional levels for as long as possible and at preventing complications secondary to... more
Rehabilitation techniques for the management of patients with amyotrophic lateral sclerosis are aimed at maintaining the patients at their optimum functional levels for as long as possible and at preventing complications secondary to disuse of muscles and immobilization. A functional staging of patients is proposed which is helpful in categorizing them in reference to the type of rehabilitative techniques required and the kinds of assistive devices needed.
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SummaryThe objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and... more
SummaryThe objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. A significant reduction in back pain, kyphosis, and risk of falls and an improvement in the level of physical activity have been achieved through the SPEED (Spinal Proprioceptive Extension Exercise Dynamic) program. In addition, the application of a “Posture Training Support” (PTS) using a backpack may decrease kyphosis and pain related not only to compression fractures but also reduce iliocostal friction. Therapeutic exercise should address osteo - porosis-related deformities of axial posture, which can increase risk of fall and fracture. Thus, the role of a thera...
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Medical textbooks were reviewed to establish how well they presented those aspects of examination of the nervous system which are important in stroke rehabilitation. In addition, information was sought concerning such factors as the... more
Medical textbooks were reviewed to establish how well they presented those aspects of examination of the nervous system which are important in stroke rehabilitation. In addition, information was sought concerning such factors as the presence of instructions for the examiner and patient, grading and interpretation of results, and the importance of observer variation which can influence results of periodic neurologic examination of stroke patients. Study results demonstrated that the description of the neurologic examination which should be used in stroke rehabilitation was often incomplete and poorly defined. Material provided little interpretation for the physical signs which might be found. Factors which might influence results of periodic examination of the nervous system in stroke patients received little attention. There is an urgent need to develop a standardized form of clinical examination to meet the needs of practitioners who assess neurologic status in stroke rehabilitation.
Research Interests: Rehabilitation, Cognition, Medicine, Physical Medicine and Rehabilitation, Physical Therapy, and 14 moreMemory, Books, Gait, Humans, Two Stroke Engine, Clinical Sciences, Public health systems and services research, Physical examination, Cerebrovascular Disorders, Motor activity, Psychomotor Performance, Neurologic Examination, Disability Evaluation, and Neurological examination
Forth-seven patients with symptomatic back pain secondary to spondylolisthesis who were not surgical candidates were instructed in a treatment program that included flexion or extension or combined flexion-extension exercises. At... more
Forth-seven patients with symptomatic back pain secondary to spondylolisthesis who were not surgical candidates were instructed in a treatment program that included flexion or extension or combined flexion-extension exercises. At follow-up, symptomatic changes were correlated with the type of exercise program. Patients treated with flexion-type exercises were less likely to require use of back supports, require job modification, or limit their activities because of pain. Although surgical treatment of spondylolisthesis has been outlined in current literature, conservative programs have not been well defined. Factors aggravating pain and a specific program for pain reduction are discussed.
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In this cross-sectional study, the bone mineral density of the lumbar spine, the back extensor strength, and the level of physical activity were determined in 68 healthy, postmenopausal women. Physical activity was determined by a graded... more
In this cross-sectional study, the bone mineral density of the lumbar spine, the back extensor strength, and the level of physical activity were determined in 68 healthy, postmenopausal women. Physical activity was determined by a graded questionnaire and varied from sedentary to heavy vocational and avocational activity levels. Bone mineral density (L2 through L4) was measured with dual-photon absorptiometry. Back extensor strength was determined with use of a strain-gauge dynamometer. Bone mineral density ranged from 0.77 to 1.49g/cm2 (mean +/- SD, 1.06 +/- 0.18g/cm2). Back extensor strength ranged from 37 to 145 lb (84.6 +/- 23.5 lb). Physical activity scores ranged from 3 to 13 (8.0 +/- 2.7). Statistical analysis demonstrated a significant positive correlation (r = 0.34, p less than 0.005) between bone mineral density and back extensor strength. Bone mineral density was also positively correlated with the level of physical activity (r = 0.24, p less than 0.05). There was a signi...
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Falls and fractures are multifactorial; therefore, multifaceted approaches are required to prevent and manage them. Reducing sedative pharmacotherapy decreases iatrogenically affected alertness and falls in the geriatric population. Axial... more
Falls and fractures are multifactorial; therefore, multifaceted approaches are required to prevent and manage them. Reducing sedative pharmacotherapy decreases iatrogenically affected alertness and falls in the geriatric population. Axial strength and stability are of primary importance. Muscle and bone loss, along with age-related disequilibrium, falls, and fractures, require innovative approaches for management. Imbalance and postural sway are two important risk factors for falls. Strengthening lower extremity muscles can decrease the risk of falls. Prevention of falls is the primary objective of a rehabilitation course. Factors contributing to the risk of falls could be intrinsic or extrinsic to the body.
Research Interests: Medicine and Osteoporosis
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... Address for Correspondence/Yazflflma Adresi: Mehrsheed Sinaki, MD, MS, Professor of Physical Medicine and Rehabilitation, Mayo Clinic College ... Kurmen Figueroa DA, Sinaki M. Significant reduction of vertebral fractures: comparison... more
... Address for Correspondence/Yazflflma Adresi: Mehrsheed Sinaki, MD, MS, Professor of Physical Medicine and Rehabilitation, Mayo Clinic College ... Kurmen Figueroa DA, Sinaki M. Significant reduction of vertebral fractures: comparison of rehabilitation of oste-oporosis program ...
We determined the bone mineral density of the lumbar spine and the strength of back extensors in 68 healthy postmenopausal Caucasian women. Bone mineral density of the second to fourth lumbar vertebrae was measured by dual-photon... more
We determined the bone mineral density of the lumbar spine and the strength of back extensors in 68 healthy postmenopausal Caucasian women. Bone mineral density of the second to fourth lumbar vertebrae was measured by dual-photon absorptiometry, and back extensor strength was determined with use of a strain-gauge dynamometer. The bone mineral density percentile ranged from 2 to 99%, and back extensor strength ranged from 37 to 145 lb. Statistical analysis demonstrated a significant positive correlation (P = 0.004) between bone mineral density and back extensor strength, even when bone mineral density was corrected for age. Bone mineral density was also significantly positively correlated with body weight (P = 0.003), height (P = 0.001), and arm span (P = 0.008). These data suggest that the strength of back muscles may contribute to the bone mineral density of vertebral bodies.
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Research Interests: Engineering, Physical Activity, Menopause, Muscle strength, Biological Sciences, and 15 moreSeasonality, Humans, Bone, Female, Regression Analysis, Muscles, Bone Density, Aged, Middle Aged, Bone Mineral Density, Back, lumbar vertebrae, Random Allocation, Medical and Health Sciences, and physical exertion
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Osteoporosis, as a multifaceted disorder, requires a multidisciplinary approach to achieve the most successful management. Osteoporosis, in general, is a preventable disorder. Maintenance of bone mass depends on several factors, including... more
Osteoporosis, as a multifaceted disorder, requires a multidisciplinary approach to achieve the most successful management. Osteoporosis, in general, is a preventable disorder. Maintenance of bone mass depends on several factors, including proper level of physical activity (PA), hormones, and nutrition. Early diagnosis of low bone mass and provision of measures to prevent further bone loss are essential. Application of proper mechanical load can stimulate osteogenic activity. The best preventive measures start in childhood, including proper nutrition and PA. Later in life, the level of PA plays a significant role. Maintaining a moderate level of PA through a regular exercise program, combined with a balanced diet and proper calcium and vitamin D intake, is fundamental to bone and muscle health. Prevention of falls and fractures need to be addressed. Both indication and type of spinal orthosis need to be addressed. In the case of osteoporosis and fragility, an exercise program needs t...
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Axial loading of the spine in patients with bone loss can result in compression fracture. We report the efficacy of progressive resistive exercise (PRE) of paravertebral muscles from prone position, designed for increasing back strength... more
Axial loading of the spine in patients with bone loss can result in compression fracture. We report the efficacy of progressive resistive exercise (PRE) of paravertebral muscles from prone position, designed for increasing back strength without back pain. We conducted a randomized controlled trial of a PRE program to decrease vertebral fracture incidence several years after program discontinuation. In our study, 67 white women (age, mean [range], 56 [49–65] years) were randomly assigned to the control (n Back Progressive Resistive Exercise Program to Reduce Risk of Vertebral Fractures M. J. Borgo, M. Sinaki = 33) or exercise group (n = 34). Participants were instructed in proper dynamic and static posture principles. All participants had biplanar radiographs of the thoracic and lumbar spine to detect fracture at baseline, 2-year and 10-year follow up. Physical activity level and back extensor strength (BES) were evaluated monthly for 2 years. The exercise group performed PRE from pr...
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The most effortless posture in humans occurs when anatomical structures that participate in upright posture are aligned with the line of gravity or close to it. In kyphosis and forward thrust of the head, weight of the head will add to... more
The most effortless posture in humans occurs when anatomical structures that participate in upright posture are aligned with the line of gravity or close to it. In kyphosis and forward thrust of the head, weight of the head will add to the deforming forces of the spine and further development of kyphosis. With bone loss, spinal deformities develop subsequent to the repetitive strain beyond biomechanical competence of the spine. Proper intervention could be biomechanical and include re-education of the spinal facet joints to the correct posture. Among the complications related to kyphosis, I will address flank pain or iliocostal impingement syndrome. There is a paucity of literature on the management of osteoporosis-related postural deformities. In this communication, I present interventions through biomechanical measures and facilitation of exercise to improve postural deformities as much as possible.
Musculoskeletal changes that are related to osteoporosis/osteopenia can be prevented or mitigated through implementation of proper osteoporosis rehabilitation programs. Osteoporosis can affect patients physically and psychologically. We... more
Musculoskeletal changes that are related to osteoporosis/osteopenia can be prevented or mitigated through implementation of proper osteoporosis rehabilitation programs. Osteoporosis can affect patients physically and psychologically. We need to treat the patient, not just the low bone and muscle mass. Being positive in our presentation is crucial for patients' compliance with the program. The physical activity (PA) and exercise interventions recommended here are evidence based and are the result of controlled trials and studies. In addition, the author has included a few caveats that are intended to emphasize avoidance of overstraining the spine beyond its biomechanical competence when interested in osteogenicity of exercise and PA. Effective back-strengthening exercises need to be devised according to the patient’s biomechanical competence.
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Revised and updated, this edition provides information on basic clinical rehabilitation medicine, including practical management of the conditions that are common in daily practice.
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Background: Iliocostal impingement syndrome is a rare, painful, and disabling condition associated with thoracic hyperkyphosis and kyphoscoliosis. There is little published literature regarding management of this syndrome. The purpose of... more
Background: Iliocostal impingement syndrome is a rare, painful, and disabling condition associated with thoracic hyperkyphosis and kyphoscoliosis. There is little published literature regarding management of this syndrome. The purpose of this case series is to report treatment outcomes for iliocostal impingement syndrome with improving posture and back muscle strength. Case Description and Methods: Thirty-eight women with thoracic hyperkyphosis or kyphoscoliosis and back and/or flank pain were diagnosed with iliocostal impingement syndrome on the basis of symptoms and spine radiographs. They were instructed in weighted kypho-orthosis use and taught a home back-extensor strengthening program. Outcome measures included posture evaluation and pain level. Findings and Outcomes: All patients reported immediate pain reduction with weighted kypho-orthosis trial. Nineteen patients returned within 2 years, and all had continued pain relief and posture improvement. Conclusions: Our findings s...
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Reduction in the biomechanical competence of the axial skeleton can result in challenging complications. Reduction of bone mass Musculoskeletal Rehabilitation in Patients with Osteoporosis – Rehabilitation of Osteoporosis Program-Exercise... more
Reduction in the biomechanical competence of the axial skeleton can result in challenging complications. Reduction of bone mass Musculoskeletal Rehabilitation in Patients with Osteoporosis – Rehabilitation of Osteoporosis Program-Exercise (ROPE)
The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga... more
The importance of exercise in skeletal health is increasingly recognized by both patients and providers. However, the safety of prescribed or recreational exercise in at-risk populations remains under-reported and under-publicized. Yoga has gained widespread popularity due to its physical and psychological benefits. When practiced in a population at increased fracture risk, however, some yoga poses may increase fracture risk, particularly at the spine, rather than increasing BMD as noted in recent popular press reports. Nine subjects (8 women) with a median age of 66 years (range 53-87), developed vertebral compression fracture (VCF) one month to six years after initiating yoga- associated spinal flexion exercises (SFE). VCF presented with back pain and occurred in the thoracic-spine (n=6), lumbar-spine (n=4) and cervical-spine (n=1). Four patients had osteoporosis by BMD criteria prior to VCF and 2 had osteopenia (median T-score -2.35; range - 3.3 to +2.0). Interestingly, all patie...